The emergence of SARS — severe acute respiratory syndrome — reminded countries that in a globalized world, diseases move as far and as fast as goods and people.
Dr. Margaret Chan was director of health for Hong Kong — a nexus of SARS — during the outbreak. Today, Chan is director general of the World Health Organization, a post she has held since late 2006.
She recently spoke with The Canadian Press about the impact SARS had on global health, whether she would use the tools employed by a predecessor in a similar situation and how she feels about a new virus that keeps pinging the world's radar.
Note: The International Health Regulations, a treaty aimed at enhancing global health security through outbreak preparedness and transparency, were strengthened after SARS. China's secrecy during the early stages of the outbreak meant the world was caught offguard when the outbreak emerged.
The following answers were edited and condensed.
CP: Is the world better prepared for a disease outbreak like SARS now than it was in 2003?
MC: "SARS was a very important event.... And many countries have learned from SARS.... The SARS event sort of gave them additional impetus and the sense of urgency for them to really revise the International Health Regulations."
"...All in all, and because of the impetus coming from the SARS outbreak in 2003, countries of this organization reviewed and also renewed and also updated the IHR and all these requirements actually paved the way for countries to build their capacity and also understand the need for transparency."
"And we have noticed that the time from event diagnosis to reporting to WHO has decreased tremendously. And the country capacity is much better than pre-SARS. It's a long way to tell you: Yes. Because of SARS, I think the world is in a much better position to detect events."
CP: But are some of those provisions better on paper than in reality? Indonesia wouldn't report new bird flu cases to WHO for several years because of a dispute over access to vaccines made from H5N1 viruses. And countries in the Middle East are clearly chafing at being identified as the source of the novel coronavirus.
MC: "In disease outbreaks, when you are doing well as a country or even as a city, you are vigilant, you are being responsible, you acted in accordance to IHR requirements, you do your global responsibility, you report ... you should deserve credit for having the capacity and the courage to tell the world."
"... (But) countries for different reasons — political and otherwise — will always ban travel, will always stop their products coming (in). And this is why I'm saying it's counterproductive, from the perspective of prompt and transparent reporting."
"When WHO joins hands with our brothers and sisters in OIE and FAO" — the World Organization for Animal Health and the UN Food and Agriculture Organization — "to say that it is safe, no need to ban travel, no need to ban products, I wish countries would listen to them. If they do, that will help countries to be much more forthcoming."
CP: Some people believe the response to the H1N1 pandemic was overblown. Has that hurt the agency's capacity to urge countries to maintain their emergency preparedness efforts?
MC: "According to the IHR, it is countries' responsibility to do emergency preparedness. Yes, of course, public opinion is important. But based on what I'm seeing, the IHR is still a live document."
CP: During SARS, the WHO issued advisories to warn travellers away from locales that were battling the disease. It was a controversial tool, at least in Toronto. Would you use issue travel advisories in a similar situation?
MC: "That tool is still open and available to WHO. But whether or not we will use it, we have to judge the situation, whether it merits that. I cannot say yes or no. ... When you're dealing with new and emerging diseases, you have no idea and you can't predict in advance what would happen."
"...In the absence of complete science and information, I think the organization would make the best decision in good faith."
CP: A new coronavirus, from the same family as SARS, emerged last year and has caused sporadic cases since. Does it give you a sense of deja vu?
MC: "I have a special interest in new and emerging infections because, perhaps, of my previous experience. I keep a very high level of vigilance."
"...We don't know enough now about the virus and about the disease to be able to say anything. Is it going to be having a mild phase that is not being detected early enough? It's just like a cough and cold? Or is it only in certain individuals where you have severe disease? ... This is the kind of situation that deserves a lot of humility and modesty but extremely high vigilance."
"When you say whether I get a sense of deja vu, well I have to say yes."